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University of Dammam

Nursing Collage
Critical Care Nursing (1610-412)
1430 -1431 H / 2010 – 2011

Care of Patient with Chest Tube

Prepared by:
Ruqayeh Al-Matrouk 207002561
Zahra'a Al-Khabbaz 208001323
Rahamah Al-Shreef 208000758
Batool Al-Shreef 208008491
Fatimah Al-Qaisoom 208007441
Zainab Al-Obeidi 208025617
Sarah Al-Abdali 207000113
Supervised by:
Ms. Khulood Bubshait
Course Coordinator:
Dr. Omnia H. Salem
Care of Patient with Chest Tube

Outlines:
 Introduction
 Definition of Chest Tube
 Purpose
 Indications
 Chest drainage systems
 Types of Chest drainage systems
Two chamber system
Three chamber system
 Care of patient with chest tube
Assessment
Drainage monitoring
Water seal monitoring
Positioning
Transporting
 Complications
 Contraindications
 References

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Care of Patient with Chest Tube

Introduction
The normal breathing mechanism operates on the principle of negative
pressure; that is , the pressure in the chest cavity normally is lower than the
pressure of the atmosphere causing air to move into the lung during
inspiration.
Trauma, disease, or surgery can interrupt the closed negative-pressure
system of the lungs, causing the lung to collapse. Air or fluid may leak into
the pleural cavity. A chest tube is inserted and a closed chest drainage
system is attached to promote drainage of air and fluid. Chest tubes are
used after chest surgery and chest trauma and for pneumothorax or
hemothorax to promote lung re-expansion.
Chest tube ( chest drain):
A chest tube is a drain placed into the pleural space to restore intrapleural
pressure and reinflate the lung after it has collapsed. It also acts to prevent
fluid and air from returning to the chest. Chest tube maintenance includes
the actions performed by the nurse or other health care professional to
keep the tube functioning properly.
Purpose:
 remove air ,fluid or even blood from pleural space.
 allow the lung to re-expand after collapsed or after partial collapsed.
 prevent reflex of drainage back into the chest.
Indications:
 Empyema: infection of the pleural space (usually following pneumonia)
 Hemothorax: blood in pleural space, May caused by traumatic (forceful)
chest injury, a tumor (growth) of the pleura, or bleeding problems.
 Pleural effusion: fluid in the pleural space(pleural effusion) usually
caused by heart failure, infection or tumors .
 Pneumothorax: air in the pleural space.

All these causes not allowing the lung to fully expand when breathe.
Which need immediate intervention

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Care of Patient with Chest Tube

Chest drainage systems


 Suction source
 A collection chamber for pleural drainage
 Mechanism to prevent air from reentering the chest with inhalation.
Types of chest drainage systems:

atrium ocean atrium oasis


two chamber system three chamber system

Types Description Comments


Two chamber  The first chamber is the  Sterile water until 2 cm is added to the
system collection receptacle second chamber which act as negative
 The second chamber is the pressure needed to exert drainage
water seal(sterile water outside and prevent air entry
until 2 cm is added to act as  The second chamber have a vent who
negative pressure) still open
Three chamber  The first chamber is the  Connected the chest tube to the two
system collection receptacle chamber system 6 foot (184 cm)
 The second chamber is the below the patient
water seal representing  During inspiration the pleural space
negative pressure become more negative causing the
 A suction control chamber is fluid level to rise
added (safest way to control  During expiration the pleural space
amount of suction) become more positive causing the fluid
level to descend
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Care of Patient with Chest Tube

Care of patient with chest tube:


Assessment:
Nursing care is directed at maintaining patency and proper functioning of
chest tube and drainage system through:
1. Assess cardiopulmonary status and vital sing every 2 hours as needed
2. Monitor type and amount of drainage
3. Mark amount o drainage on collection chamber hourly
4. Prevent any looping and twisting of tube
5. Refill the water system with sterile water
6. Check the connection of all tubes
7. Assess the patient response and pain characteristics
8. Assess the insertion sites for bleeding or infection sings
9. Change the dressing twice daily and when solid

Drainage monitoring Water seal monitoring:


Assessing and documenting the color,  Monitoring the water seal is failed till 2
consistency, and amount of drainage while cm in the chamber
remaining alert to significant change.  If suction is ordered, the nurse have to
A sudden: monitor the water level is at order level
 Increase indicates hemorrhage which is usually at 20cm H2O
 Sudden patency in obstructed tube  Add only sterile water to the system
 Decease indicates chest tube  The air vent should never be occluded
obstruction  Checks the suction gauge for the
 Failure of chest tube or drainage desired suction level
system
Required:
 Immediate alleviation of obstruction
by repositioning
 If clot is visible, straighten the tubing
between the two ways and raise the
tube to enhance the effect of gravity

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Care of Patient with Chest Tube

Positioning:
 Ideal positioning for chest tube is semi-fowler’s
 Turning the patient every 2 hours to enhance air and fluid evacuation
 Encourage breathing and coughing exercises and ambulation
 Administer of analgesic before these exercises
 Teach the patient to splint the chest wall by below or cross fingers
during breathing exercise, coughing or sneezing to avoid pain.
Transporting:
 Constant assessment during transporting should be done to prevent
inadvertent chest tube removal (causing recurrent pneumothorax)
 Maintain chest drainage system integrity by positioning it below
chest level and secure it to the foot of the bed
 The suction must be implemented
 Check for air leak, dressing, water seal integrity, water level and
drainage
Complications:
most serious complication resulting from tube placement is tension
pneumothorax rustling from obstruction in the drainage system
 bleeding from an injured intercostals artery (running from the aorta)
 accidental injury to the heart, arteries, or lung resulting from the chest
tube insertion
 local or generalized infection from the procedure
 persistent or unexplained air leaks in the tube
 dislodged or inserted incorrectly
 insertion of chest tube can cause open or tension pneumothorax
 Puncture of liver or spleen. This is entirely preventable; insertion site is
in the nipple line, between 4th and 5th ribs!
 Passage of tube along chest wall instead of into chest cavity. In this case,
widen and deepen the dissection between the ribs, and make sure the
insertion of the tube follows this path

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Care of Patient with Chest Tube

Contraindications:
 Refractory coagulopathy,
 Lack of cooperation by the patient,
 Diaphragmatic hernia.
 Scarring in the pleural space (adhesions)
 Infection over insertion site
 Uncontrolled bleeding diathesis

Reference:
 Suzanne C. Smeltzer, Brenda G. Bare, Janice L. Hinkle and Kerry H. Cheever,
2008: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Eleventh
Edition, Lippincott Williams & Wilkins
 Gonce P. Morton and Dorrie K. Fontaine,2009: Critical Care Nursing a holistic
approach Ninth Edition, Lippincott Williams & Wilkins
 Nettina, Sandra M.; Mills, Elizabeth Jacqueline,2006: Lippincott Manual of
Nursing Practice, 8th Edition, Lippincott Williams & Wilkins
 Carol R. Taylor, Carol Lillis, Priscilla LeMone, Pamela Lynn, 2008: Fundamentals
of Nursing The Art and Science of Nursing Care , Sixth Edition, Lippincott
Williams & Wilkins
 www.drugs.com/cg/chest-tubes.html
 http://www.nursing-sa.com/vb/showthread.php?t=18904
 http://www.palnurse.com/vb/showthread.php?t=54816

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